Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, Alex. Can you hear me? Uh Yes, I can. Yeah, perfect. Um Yeah, share your slides whenever you're ready. If you need any help, I'll be here to support. Ok. And thank you again for taking the time to come today. Otherwise let me just. Ok, slides out. Uh Let me great. Is that 23 fre? Mm, perfect. Ok. So um yeah, um as John said, my name's Alex, I'm a plastics registrar um and research fellow working down um in Oxford and I'm gonna talk to you a little bit about um alternative pathways into higher surgical training. Um and in particular the crest route which some of you may have come across or may have never heard of. Um, for a number of reasons I ended up um not doing formal core training and actually improving my competencies using this. Um I had no real idea about it beforehand. Um and I think it's really useful just to be um aware of if, if nothing else. Um, so you may have already seen, um, you know, a few slides like this, this er morning, you know, this is that classic er slide that you get shown at med school. And this is supposedly how your career is going to look. I think we're all probably aware that this isn't always the case and actually most of us will end up taking time out to do extra bits and Bobs. And I think that this is a much more realistic slide showing what the pathway through your medical training will look like. Lots of people will take time out during med school after foundation training and so on. And also important to remember that, you know, traditionally, we think of a consultancy as being the end of your training. Um But plenty of people now are choosing to take um locally employed specialty or specialist grade jobs and they're all, you know, completely um reasonable ways to accommodate your career, right? So what is the crest form that we're talking about? You may have seen this, this is the crest form without an H. So, Cres T um and this is the way that you can prove that you've achieved competencies of foundation training. Um If you haven't done formal foundation training, that's not what we're talking about. Um This is what you need to apply into CT or ST one. but it's not how you prove your competencies to apply into higher surgical training. This is the form that we're talking about Crest with an H. Um And this is one form that you can use to prove your competency to apply higher surgical training and you can see there that it's for all of the main surgical specialties. Um So as I've said, it's a way of um showing that you've achieved equivalent competencies to those who have completed core training. And this could be done in the UK. So you could be a UK trainee who has not done formal core training. You could be an overseas trainee who has come to the UK to prove that um competencies and apply to high surgical training. You could be an overseas trainee who has proved them overseas. And indeed, I've now met some UK trainees who have gone overseas to sunnier climates like Australia and done equivalent core training over there, proved their competency and come back and applied into higher training to, to get your quest form signed off. You don't technically need a portfolio, you don't need your exam and you don't need to have achieved any specific courses. However, those could all be used as evidence um to help you sign off your form. Um And of course, it may be necessary to have those things for your higher surgical training application anyway. Now, certainly you need your MRC S to apply. So like I said, amongst other prerequisites, the crest form makes you eligible. That's all it does. It makes you eligible to apply. So obviously you won't have applied for ST three yet. So this is what the form looks like when you go through. Um It's the same for pretty much every surgical specialty, you have to uh pick a, an option for showing that you've achieved your, er, competencies. The top one is probably the most common. That's if you're in CT two and you're expected to who they are. CPD at the end of the year, you click. Yes. If you've already finished core training, that's the next one down. You click. Yes, that means that you've already finished, uh, you maybe didn't get a job or you didn't apply. And then finally, there's that third one hidden at the bottom that says uh you're able to attach specified alternative competencies and that this is where you would use the, the, the crest form. So this is what the document looks like. Um You get it on the resource bank and or it's, it's free to access. You don't need to start an application. So it's worth just familiarizing yourself with or having a look. Um And yeah, you can see here that it, it it is, it is a way of, you know, approving your, your competencies. Um What's important to look at here is that when you're getting it signed off, you don't need to have one consultant, sign it off, you can have multiple um but you do need the whole form completed and the person that signed it off has to have worked with you for a minimum of three months. Um There's this final little bit here on the first page it often causes anxiety or worry for people. This form hasn't been updated since 2021 and it still says that if you finished higher training, having gone in via this route that you'll get what's called a CSRC P or a certificate of eligibility for specialist registration combined program rather than act. And that gives some people some worry because um CAS aren't always seen as the same overseas, that's not actually strictly speaking true anymore. In terms of what you get, if you go via this route, they just haven't updated the form yet. So we'll just take a slight detour into what sort of specialty registration is and how you get onto it. The most formal standard traditional route is the CCT. Um You know, if you go through formal training, formal core training, formal specialty training, you A RCP at the end, you can apply and you get a CCT and you're on the specialty register. Then if you've done some of your training, informal training and some out of formal training, um you used to get what's called a CSRC P. Um And then if you did all of your training outside formal training, you used to have to submit a portfolio um to show that you had equivalent competencies. Um and then this would um afford you a Cesar. So this is the one that you used to get if you use the Crest form. They actually did all of that in about two years ago. I think it was 2022. Um, and now there are just two ways of getting onto the specialty reg. So you get a CCT if you have done a minimum number of years in higher training and that's different for all the specialties. But, but, um, it's, it's, it's, yeah, I, I'll go through that in a second. Um, all the portfolio routes. So if you haven't done the minimum number of years, um you have to submit a portfolio which is equivalent to the OT S are, but we don't really know how it's gonna work cos it's, it's quite new. But what this shows you is if you've done the minimum number of years, even if you've done the crest form, you will get act. Um So this table on the right, if you have a little look at, um you can actually see on the right hand column, that's the minimum number of years required to get a CCT. And the left hand column is the um number of years of higher surgical training. And you can see across the board that the length of formal, higher training is longer than the minimum number of years required. So if you go into higher training, you will get a CCT and indeed, the GMC are even retrospectively granting CCT S to those who have um done, got the CSRC P. So I think that should sort of reassure people that you will end up with the same qualification if you do go the alternative route. And this is just some documentation from the GMC and colleges in Deer saying that it's up to the DE and the TPD S to identify people who should be getting CCT S rather than CSAR or CS R CPS. And this is all in, built into the sort of the training program now. So it shouldn't be an issue. So just going back to what is Crest and how you do it. Um This is what the consultant that you're asking to sign it off would see and this is what you as a candidate would need to prove. So you can see underlined here. Um The consultant, the guidance for the consultant is that they don't need to have seen you do all of those things, all of the competencies, but they do need to be satisfied that you have achieved them and you can do that. So that could either be because they have observed you um or they've spoken to a colleague, another supervisor who has um seeing you or that you, I guess have a W ba in your portfolio showing that you can do it. So that's why it's worthwhile keeping a portfolio or attending courses because you can then show competency in maybe aspects that you wouldn't normally do. I've also highlighted the fact that they need to use their initials and it's not just the tick box I've seen people or heard of people who have had their forms rejected because they had them ticked and not initialed, which obviously will be a disaster. You can also see here that you need to have a hospital stamp. Now in the UK, that's normally, you know, the, the admin on the ward will have one. it's pretty easy to get but it's definitely not worth leaving it up until the last minute. So these are actually the competencies that you have to get signed off. It's just two sections. The first is professionalism and leadership. Yeah, very simple stuff. You know, can you take a history? Uh can you make a diagnosis? Can you, you engage in audit all of that all things that you should be doing if you're part of a normal team and then this is the generic core surgical skills. Again, not very many sections. Um Can you make an incision put local in do a who checklist? Nothing should be too surprising there. The only thing is you might look at it and realize that your specialty may not do some of these things. Now, I I'm a plastics trainee and we don't really use endoscopy or laparoscopy very much. I mean, if we do something's gone horribly wrong. Um So this was not something that I had been observed by my bosses, but I had W BS from previous rotations and I'd been on basic surgical skills. So I was able to show that I was at least as competent as any other core trainee. Um So these are why having a portfolio or courses may be really valuable. So how do you actually do it? Well, you need a job that's going to support you to do it. And there are plenty of locally employed jobs and trustor jobs out there. They're not all the same. Some will be purely service provision, some will afford you more training opportunities. You need to talk to people that are doing those jobs. You need to talk to bosses, you need to potentially talk to departments. You already know and say, would you support me through this? I had a department that was very supportive and understood my aims and we're very happy to, you know, walk through the whole system with me. So that was great. But you need to be proactive, you need to treat your time in that job as if you're doing core training. So you need to at least get someone who is going to act like an educational supervisor for you and talk to them about the form and how you're going to evidence your competencies for them. Every supervisor will be different and want a different level of evidence. Um And you know, you need to talk to them about what it is that they want so that you're not surprised when you come to get it signed off. You don't want any last minute surprises. It means you can't apply. Um You obviously need to keep log work. I'm sure you already are anyway. Um But you need to think about whether or not using the same portfolio as the core trainees use is right for you. Now, it is money. It's I think 260 lbs so you can claim the tax back on it. Um which is a lot of money, but it, that is what your core training colleagues would have to do. I chose to because I needed W ba s um on it for my application for ST three. Your specialty may also require that. So it's worth looking at that for yourself. Um You can obviously use that portfolio as evidence for your quest form as well. So that's a bonus. Um You will have to do appraisals every year. Um as any locally employed doctors, I think just treat that like an ACP as if you're doing um core training. Um And you know, make sure that you're on track and you're at the point that another trainee would be at your stage. And it's not just about the form you need to get your exam done, you need to understand your specialties, portfolio scoring and collect that evidence, attend the courses that you need to attend. You should have a study budget. Um As a locally employed doctor, uh we had 800 quid a year that was very easy to claim actually. Um And you need to hold yourself accountable. You're not going to have anyone breathing down your neck and making sure that you're progressing like your trainee colleagues are. So, you know, it's a little bit harder in that way to make sure that you're keeping up. So we've spoken about the differences. Um I think one of the, you know, we've spoken about most of these differences, but one of the broad differences that you can see is actually being able to include slightly more like less traditional aspects to your job. So, research education, et cetera, if you go the alternative pathway and certainly I was able to stay 50% research throughout pretty much all of my core training equivalent, which was massively valuable for me with an interest in research. Um So why might you go this route? Um Well, if you have greater than 18 months of surgical experience before core training, you're ineligible to apply for core training. So you'd have to. And that could be because you're an overseas trainee. Um because life has thrown you some curveballs which is completely reasonable or that you've taken a meandering route. And again, these are all completely acceptable reasons to end up, you know, um at this point and to know that there is a way that you can still get into higher training, I think is really, really useful. Um You may have geographical reasons to want to stay in one place responsibilities, family, et cetera. Or a lot of, you will have been affected by the new foundation training issues. You may just not want to be kicked off to somewhere else in the UK for two years and you might want a bit of control over that. And I think that's completely reasonable and finding you might have AAA link to a department mentorship already there or just have a particular interest in working in one specialty in one department. What are the negatives? Well, you're gonna have less job security. Um A lot of these locally employed roles are for one year. Um You probably will have to rein interview at the end of that year. I mean, there are some now two year sort of rotational equivalent jobs advertised which might give you that protection, you're going to have less protection in terms of training requirements. Um Your core training colleagues have um have technically got protection for a minimum number of theater sessions, clinic sessions, et cetera, which you won't have. And whether or not those actually truly exist in core training is up for debate, but that's something to be aware of. Um you may have less exposure to other specialties, which could be a bad thing for applications. So in plastics, it doesn't matter. Um But in some specialties like ent you get points for having done. I don't know max about plastics, et cetera. So that's also worth knowing. Um You said that no one's going to hold you accountable and you might get some people that comment negatively on the fact that you haven't done the traditional route in terms of the positives. While we said geographic stability, you don't need to keep proving yourself every six months, which surgery can be, you know, invaluable. Um You can get more time in that one specialty you want. Um you know, most poor training, even themes will only give you a year in one specialty. So, you know, you get more than that um and seeing things through like research and quips means that you can actually do some meaningful work. Um And following on from that, um actually getting involved in the clinical governance of the department sounds a bit dull but you, you, it's not that long way until you're gonna be thinking about being a consultant and actually understanding how a department runs and how to make a meaningful change in a department can be a really invaluable insight um as part of your training. And I don't think you get that unless you're in a department for a longer time. And we've spoken about integrating stuff like research and training and teaching into, into your jobs. We'll brush over this quickly. But recently, we actually did a freedom of Information Act request looking at people getting into training via this route. It was for one year and I won't go through all the numbers. But essentially the crux is, is that of the about 500 posts that were taken up, 20% of them went to people who had gone via the quest route. So people are doing it. It it is, it is possible. It's not just a pipe dream. Um You can have a read through this, but essentially this was one year's worth of data that we didn't have much granular data, but it's useful to know that it is possible. So I guess finally, is this right for you? Why are we even talking about it? Um Only you can know that I didn't plan to go via this route. I sort of ended up, I was applying during the COVID years. I got a theme job in a different dery to my partner and I didn't really want to be locked down again and living in a tiny little one bedroom flat in that particular city. Well, she lived elsewhere. So I actually turned down the job and took up a locally employed job with the trust that I had previously worked in. And that ended up being the right thing for me. I had no idea about this route before I started, which meant that it was all a bit of an anxious time. So I think what's useful for you is to know that this exists, life may change and it might throw you a curveball and you might end up needing to know about it and that's completely fine. But I think it's important to understand, this is not the easy route, it's not a back door into surgery. There is no easy way into surgical training and no easy way through surgical training. Um And I don't think you need to stop thinking about, um, you know, preparing as if you are applying for core training because if you aren't getting into core training because of your portfolio, then that's going to be the same issue when you come to higher surgical training. So you need to work as if you are applying for core training, but be aware that there are different routes if you need them. And with that, I'll bring it to an end and I'm very happy. I suspect there will be some questions, either ask them on the chat or that's my email. And if anyone's got any questions that they don't want to ask on the chat, but want to have a conversation about sort of this route, please feel free to send me an email. I'd be very happy to answer any of those. Thank you very much for, I know that we've done, but I appreciate you taking means a lot to me. As I see experience, any tells you just have to find out yourself. Um But thank you for coming today. Um If anyone questions, fire away in the